Nurses Pushing Propofol for Conscious Sedation -Your Thoughts? - page 5

I would be interested in getting feedback from GI nurses that are involved in propofol sedation in settings with and without anesthesia. Your thoughts and experiences please. Thank you, Randy... Read More

  1. Visit  nola1202 profile page
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    I would encourage you to tell the performing MD your experience in writing.
    Then I would get another MD that is willing to listen and work with you.
  2. Visit  health professinal profile page
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    Quote from nola1202
    I would encourage you to tell the performing MD your experience in writing.
    Then I would get another MD that is willing to listen and work with you.
    Thanks. Yes I did that. Thankfully I won't have to undergo a colonoscopy for another 10 years.
  3. Visit  health professinal profile page
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    [font=bell mt][color=#17365d]follow-up: i just received a copy of the report sent to my pcp re the procedure. it states, "the anesthesia plan was to use moderate sedation..." but under physicains orders, it mentions nothing about a sedative. although the dosage line on my copy is not very clear, it appears to state merely "1. start iv with 500 ml of 0.9% ns [normal saline]... 2. oxygen therapy...3. discharge...". as i suspected, i was deceived and not given fentanyl. and even though i had been screaming in pain, it goes on to state, "the colonoscopy was performed without difficulty. the patient tolerated the procedure well..." . note: my signed consent was done on an electronic pad on which i repeated again,"no sedation, analgesic only" before my signature.
  4. Visit  swift125 profile page
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    If you specified no sedation/analgesic only and they gave you sedation, you probably have a cause of action. It's terrible that anyone whould lie to a patient like this. I have had 3 colonoscopies and always spoke with the doctor first and verified that she would not administer sedation; and just for safety we write this on the consent and both sign it. My last one use the electronic consent, we wrote the no sedation/fentanyl only on a progress note, both signed it and I gave it to my wife before the procedure began. One nurse loudly questioned why I insisted that we document this; my GI doc answered: "because more than a few patients have been promised a sedation-free/fentanyl only exam only to be given sedation anyway; many people do not want the creepy benzo amnesia and or loss of control.......many patients will not pay for propofol which is often unecessary for screening colonoscopy,,,most of the GI docs get theirs unsedated anyway....any more questions?"
  5. Visit  wtbcrna profile page
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    Quote from swift125
    most of the GI docs get theirs unsedated anyway....any more questions?"
    Reference?
  6. Visit  swift125 profile page
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    with all due respect wannabecrna-it's a common sense issue...any any of the doocs at your facitlit...really, you ask for ref???
  7. Visit  wtbcrna profile page
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    Quote from swift125
    with all due respect wannabecrna-it's a common sense issue...any any of the doocs at your facitlit...really, you ask for ref???
    I have known a lot of gastroenterologists and none have foregone sedation for their personal procedures. Simple fact no one can speak for a large population without having done some sort of study/survey. Commonsense has no place in this. Commonsense to me would indicate that a GI doc would want sedation with propofol only based on the hundreds of thousands of patients research has shown this to be the most beneficial/satisfying for.
  8. Visit  swift125 profile page
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    Quote from wtbcrna
    I have known a lot of gastroenterologists and none have foregone sedation for their personal procedures. Simple fact no one can speak for a large population without having done some sort of study/survey. Commonsense has no place in this. Commonsense to me would indicate that a GI doc would want sedation with propofol only based on the hundreds of thousands of patients research has shown this to be the most beneficial/satisfying for.
    sorry wannabecrna...you are wrong.I know a lot of GI docs (not as a nurse) and most skip the dubious benefits of sedation for their own endo procedures. Many patients (myself included) specify fentanyl only (yes, we request this and the doc approves or disapproves the request)............I won't argue with any nurse about this............please lay off the cut and paste "references" your "experience" is lacking..maybe this works as a prison nurse, but in the real world patients have the right to request whatever drugs they want (or refuse) for elective procedures. The physician can agree or not...it's not up to a nurse (CRNA included).............to make this decision.
  9. Visit  wtbcrna profile page
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    Quote from swift125
    sorry wannabecrna...you are wrong.I know a lot of GI docs (not as a nurse) and most skip the dubious benefits of sedation for their own endo procedures. Many patients (myself included) specify fentanyl only (yes, we request this and the doc approves or disapproves the request)............I won't argue with any nurse about this............please lay off the cut and paste "references" your "experience" is lacking..maybe this works as a prison nurse, but in the real world patients have the right to request whatever drugs they want (or refuse) for elective procedures. The physician can agree or not...it's not up to a nurse (CRNA included).............to make this decision.
    Apparently, you are not reading my post very well and if you can't quote a study that did a large sample survey of gastroenterologists then you or I neither one can speak to what the majority of GI docs would want. The GI docs I know would want a anesthesia provider doing the sedation with propofol.

    When I do sedation it is up to me, the patient, and the physician (in that order) how the sedation is accomplished. I have never given a medication for a GI doc that didn't have a physiological reason behind ie. glucagon for an ERCP. When I am doing the sedation as a CRNA then the ultimate choice of drugs is up to me not the physician or the patient if we cannot come to an agreement before hand then the patient and the physician can find someone else to do the sedation. I don't work in a supervised environment, and even if I did I would never be medically directed by a gastroenterologist. What you are suggesting only increases the vicarious liability for the gastroenterologist.

    I don't really care if a person only wants fentanyl for their GI procedure, but the research shows that propofol sedation works best for the vast majority of GI procedures/patients.

    I am not a prison nurse anymore and I haven't been a prison nurse since 1999. I am CRNA and I have worked as an anesthesia provider in several states and several different types of practice, if anyone is lacking in experience it is you. Before becoming a CRNA I provided sedation in ICU setting since 2001.

    FYI: I never provided sedation services to any inmates while a prison nurse.
    Last edit by wtbcrna on Sep 4, '11
  10. Visit  Horseshoe profile page
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    Quote from swift125
    .many patients will not pay for propofol which is often unecessary for screening colonoscopy,,,most of the GI docs get theirs unsedated anyway....any more questions?"

    Quote from swift125
    with all due respect wannabecrna-it's a common sense issue...any any of the doocs at your facitlit...really, you ask for ref???

    Why did you open up the floor to "any more questions," then go on to get all ruffled when there was one?!

    I agree that if you are going to make sweeping statements like "most of the GI docs get theirs unsedated anyway," you should be perfectly willing to back up that statement with data of some kind. If what you say is true, I would find that very telling, so I'd love to see that statement verified.
  11. Visit  PMFB-RN profile page
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    Nurses Pushing Propofol for Conscious Sedation -Your Thoughts?

    *** My thoughts = A normal, standard, safe practice. One that has been in use for a number of years (since 2006) in both the hospitals were I work. It's use is limited to ICU and rapid response RNs in a monitored enviroment.
    If I were having a procedure I would ask for propofol.
  12. Visit  nola1202 profile page
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    I'll be honest that stuff scares the crap out of me. It does work well for pt's who do a lot of drinking or high tolerance for pain pills, *not processed via liver.
    Outpt setting dental office bagged a pt for over an hour till 911 got there. We were last on the list because we were a medical office.
  13. Visit  wtbcrna profile page
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    Quote from nola1202
    I'll be honest that stuff scares the crap out of me. It does work well for pt's who do a lot of drinking or high tolerance for pain pills, *not processed via liver.
    Outpt setting dental office bagged a pt for over an hour till 911 got there. We were last on the list because we were a medical office.
    Propofol is broken down by the liver just like most other drugs used for sedation. Propofol, like all IV meds, does bypass 1st pass elimination. Propofol works by GABA A receptors which is different than Versed or fentanyl giving it a different site for patients that are harder to sedate. Patients that are chronic pain patients and/or are on benzos usually require higher dosing with propofol just like they do with benzos and opioids.

    Propofol wears off in minutes after a single injection, if you were still effectively bagging a patient an hour after a single dose of propofol it wasn't from the propofol. It was from other co-administered drugs, continued hypoxia/hypercapnia, and/or patient comorbidities.

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